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CQC identifies worrying trends in care for mental health crisis

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The police are more likely to treat people going through a mental health crisis with compassion and respect than specialist mental health staff, suggests a worrying new report.

In particular, the research found healthcare professionals in accident and emergency departments appeared to lack compassion and warmth when treating people in crisis, especially those who had harmed themselves.

“We found that when people do receive help, hospital and mental healthcare staff are not always compassionate and caring”

Paul Lelliott

But it also found specialist services like crisis resolution teams and community mental health teams – predominantly made up of mental health nurses – did less well than police or ambulance staff when it came to providing timely support and taking concerns seriously.

The Care Quality Commission report – titled Right here, right now – included a survey of around 1,800 people who had experience of different types of crisis care.

Of those who had received care and support from charities and volunteers, 86% said they felt their concerns had been taken seriously. But just 37% of those who found themselves in A&E said the same, as did 44% seen by a crisis resolution team at home and 48% seen by a community mental health team.

“She told me I would have to lie on the floor of the toilets if I needed to lie down that badly”

Mental health patient

Sixty-five per cent of people who had encountered the police while going through a crisis in a public place said they received the help they needed in a timely manner, but that went down to 41% for a crisis resolution team that saw people at home and 38% for a community mental health team. The proportion was just 35% for those seen in A&E.

One person who contributed to the report described feeling “terrified, humiliated and upset” because of the way they were treated in A&E.

“The triage nurse was very dismissive and said there were no cubicles free and that I would have a long wait,” said the contributor. “She told me I would have to lie on the floor of the toilets if I needed to lie down that badly. They accused me of self-harm while I was in the toilets, which was not the case.”

The CQC said the national review showed the NHS and other public services were failing to ensure people could access crisis care around the clock.

“What’s more we found that when people do receive help, hospital and mental healthcare staff are not always compassionate and caring,” said Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health.

“Worryingly, many people told us that when they were having a crisis, they often felt the police and ambulance crews were more caring and took their concerns more seriously than the medical and mental health professionals they encountered.”

However, the report also flagged up some examples of excellent care after the CQC inspected crisis services across 12 areas.

“It is clear there is still a long way to go to make sure everyone is treated compassionately in the right place at the right time”

Alistair Burt

These included crisis and support arrangements in the London Borough of Lambeth, one of several areas with a triage scheme where mental health nurses work directly with the police.

The Department of Heath funded nine police forces to run so-called “street triage” schemes between 2013 and 2015, with an evaluation being carried out by University College London.

“In these schemes, mental health nurses accompany officers to incidents where police believe people need immediate mental health support,” said the CQC report. “Initial results are positive with pilots appearing to show a substantial reduction in the use of section 136.”

About 26 out of 39 police forces in England are currently running similar triage schemes and the CQC said there was evidence the model could be adapted to meet local need.

In Lambeth, for example, a mental health nurse is on hand round the clock to provide telephone advice to police officers and can also be called in to do some face-to-face assessments.

The report found many people go to see their GP first when having a mental health crisis and 60% of those who had done so were satisfied with the experience.

However, the report said there was a need to ensure practice nurses were trained to support people with mental health problems after a 2014 survey found 42% reported having no training in mental health and wellbeing.

The same survey found 81.5% felt they were carrying out mental health and wellbeing responsibilities without relevant training.

“Approximately two-thirds of respondent clinical commissioning group leads felt that nurses should be trained to carry out annual reviews for people with dementia, behaviour change, alcohol and drug abuse, or who self-harm,” said the CQC report.

“Yet 15% of respondent GPs felt that courses were often too expensive and only 53% would offer protected time to complete e-learning courses,” it noted.

“Mental health nurses in particular are experts in providing the care that is needed and in intervening early so the most serious symptoms can be avoided”

Peter Carter

The Royal College of Nursing said nurses could play a key role in improving services and providing early support that could prevent crises from happening in the first place.

RCN general secretary Peter Carter stressed there was “compassion and care in many settings”, but added there was a need more investment in trained staff.

“Mental health nurses in particular are experts in providing the care that is needed and in intervening early so the most serious symptoms can be avoided,” he said.

Alistair Burt, minister for community and social care, said the government was working to tackle historic underfunding of mental health services and had set new targets for mental health care.

“We asked the CQC to do this investigation so we could shine a light and better understand the perspectives of people who have experienced a mental health crisis,” he said.

“It is clear there is still a long way to go to make sure everyone is treated compassionately in the right place at the right time,” he added.

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Readers' comments (2)

  • I find it hard to believe that Greater Manchester Police would be treating mental health patients better than health professionals though the health professionals in the Greater Manchester area are in my experience not very professional at all.
    Stuck in the middle ages. Need to step up to the plate.

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  • not what I have heard in the media following a recent tempted suicide and the scandal of the selfies. the police may kindly talk people down from jumping off somewhere but then cart them off to be sectioned and imprisoned in some secure unit on the recommendation of two doctors - mental health act and probably be forced into taking medication which they may not necessarily need and which can cause them further harm. what sort of middle age barbarism is that. at least in Europe there is greater understanding and measures taken to help the individual but not to take away their freedom and their right to end their life if that is what they wish. with the right support many, but not all, may be dissuaded and grateful for not taking this route but it requires empathic understanding and support in finding alternative ways to live not punitive measures and locking them away in some substandard mental facility.

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